On October 27, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement on screening for colorectal cancer. For the first time, the Task Force is recommending that screening start at age 45. This is a B recommendation, meaning the USPSTF recommends the service; that there is high certainty that the net benefit is moderate; or there is moderate certainty that the net benefit is moderate to substantial.
The Task Force continues to strongly recommend screening people who are 50 to 75 years old. This is an A recommendation, meaning the USPSTF recommends the service and that there is high certainty that the net benefit is substantial. Overall, people aged 45 to 75 should be screened to reduce their risk of dying from colorectal cancer.
For adults ages 76 to 85, the Task Force continues to recommend that the decision to screen be made on an individual basis. This is a C recommendation, meaning clinicians may provide this service to selected patients depending on individual circumstances; however, for most individuals without signs or symptoms, there is likely to be only a small benefit from this service. These draft recommendations all apply to adults without symptoms and who do not have a personal history of colorectal polyps or a personal or family health history of genetic disorders that increase the risk of colorectal cancer.
Background for the New Recommendations
Colorectal cancer is the third-leading cause of cancer deaths in the United States. Despite strong evidence that screening for colorectal cancer is effective, about a quarter of people ages 50 to 75 have never been screened.
“Unfortunately, not enough people in the United States receive this effective preventive service that has been proven to save lives,” said Task Force Chair Alex Krist, MD, MPH, Professor of Family Medicine and Population Health at Virginia Commonwealth University (VCU); clinician and teacher at the Fairfax Family Practice Residency; Director of the Virginia Ambulatory Care Outcomes Research Network; and Director of Community-Engaged research at the VCU Wright Center. “We hope that this recommendation to screen people ages 45 to 75 for colorectal cancer will encourage more screening and reduce people's risk of dying from this disease.”
Black adults are diagnosed with colorectal cancer more often than other populations and are more likely to die from this disease. The Task Force recognizes this disproportionate risk and encourages clinicians to offer recommended colorectal cancer screening to their Black patients beginning at age 45.
“New science about colorectal cancer in younger people has enabled us to expand our recommendation to screen all adults starting at age 45, especially Black adults who are more likely to die from this disease,” said Task Force member Michael Barry, MD, Director of the Informed Medical Decisions Program in the Health Decision Sciences Center at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School. “Screening earlier will help prevent more people from dying from colorectal cancer.”
Recommended Tests
In this draft recommendation, there are two types of tests that are recommended to screen for colorectal cancer: direct visualization tests and stool-based tests.
“There are many tests available that can effectively screen for colorectal cancer,” said Task Force member Martha Kubik, PhD, RN, Professor and Director of the School of Nursing, College of Health and Human Services at George Mason University. “We urge primary care clinicians to discuss the pros and cons of the various recommended options with their patients to help decide which test is best for each person.”
The Task Force’s draft recommendation statement, draft evidence review, and draft modeling report have been posted for public comment at uspreventiveservicestaskforce.org. Comments can be submitted from October 27, 2020, to November 23, 2020, at uspreventiveservicestaskforce.org/tfcomment.
